Respect in Private Service

I’ve worked private EMS for a long time and it was the profession that helped me write Twenty-Five at the Lip. The private industry has its fair share of pros and cons, but as providers we should be especially mindful of how we are perceived in our practice.

Recently Uniform Stories published an opinion piece about why EMS doesn’t deserve higher wages. Now the writer seems to have taken a great deal of flack for his opinion and while I don’t necessarily agree with the overall tone of the piece, he does have some valid points. Particularly the point about requiring higher educational standards.

To be fair, I have to agree with the argument about higher educational standards. The problem though doesn’t necessarily sit in the hands of EMS providers, rather state officials who maintain the standards of certification.

Not to compare apples to oranges, but we aren’t nurses. EMS has been around for the better part of 40 to 50 years while nurses have been around much longer – prior to the Amercian Civil War. Nurses have been around long enough to not only develope a very specific educational criteria, but also to set standards and pace for medical practice. They’ve earned their place not only in medicine, but as a respected educational outlet.

The tip of the problem with EMS education is that we have very good educational standards, but we don’t have instructors who know how to teach. In my own medic program my instructor left halfway through because he was offered a better job leaving those of us who had dropped $5,700 (Yea, I’ve been a medic a while) out to dry. Fortunately we had other instructors in the wings to pick up where that particular jerk left off, but the problem remains that those who teach EMS aren’t teachers or professors; they are professional EMS workers who happen to also teach their profession on the side. The standards for certifying EMS instructors are often meek and informal.

A large number of these EMS schools have been run rather fly by night. Until recently many were not even affiliated with an actual college or university. Meanwhile in the UK a paramedic is required to carry a Bachelor’s Degree. These are the educational standards we should be pushing for if we want higher pay and more respect.

But respect doesn’t simply fall in our laps because we want it to. Respect is earned through displays of precessionalism and competency. Knowing your local protocols is paramount, but eating our young because they don’t walk out of EMT or Medic school as God’s gift to modern medicine makes us look like amatures.  Competency is important, but we can’t lose sight of the fact that we do this job to serve the public and part of that job is having the capacity to be compassionate, caring, and humble human beings.

My mother told me a long time ago, “Anything you do should be done as if it was going to be on the front page of the newspaper.” In our case this is incredibly true because a lot of what we do ends up there. Check your image before stepping out of your rig: Is your shirt tucked in? Are you clean shaven or is your beard/mustache in good order? Do you have food stains on your shirt? If you can’t say yes to these basic questions you need to evaluate why it is that you deserve a higher rate of pay and respect.

How do you handle yourself when you walk into a facility? Those of us in the private sector must have a profound understanding that our employer’s business (our job) depends on how we handle ourselves in these places. It is imperative that we maintain those relationships, not only to keep those nurses, administrators, and our bosses happy, but because without those contracts and arrangements we don’t have a job. You might have Satan’s Little Helper as a dispatcher, but that’s not the fault of your patient or the staff member you are getting report from.

For those of us who work private we have an especially difficult hurdle to negotiate when it comes to our image and ability. There is a nurse at a local ER that hates, and I mean hates, private EMS and volunteers. I once saw her refer to a volunteer firefighter as a “fake firefighter”. In an episode I recalled in Twenty-Five at the Lip I brought an unresponsive patient to her ER fully worked up with a professional report ready to deliver, but she was more interested in why my private service was called rather than the fire department. I could have walked into this trap, but I’ve been in this business too long to fall for that sort of garbage.

Professionalism isn’t always knowing your protocols and treatments. Sometimes it is knowing when to keep your mouth shut. People like this are miserable and know that if they call and complain about you there is a high chance of losing your job. Take a piece of advice from the penguins in Madagascar: “Smile and nod boys. Smile and nod.”

Private EMS isn’t always the ideal service. I’ve worked for some really lousy people who shouldn’t have been running an ambulance company. One of them even did federal time for Medicaid fraud after the company went under. These types of bosses don’t mean what they put into their mission statements which are often littered with words like “commitment”, “pride”, “professionalism”, and “service.”  Employees who are new to EMS often find themselves jaded and unmotivated due to lack of decent pay and equipment as well as long hours doing over long distances. It doesn’t take long for companies like these to get reputations for being sub-par, the employees dragging the reputation of the company down farther when their uniforms look lousy, their trucks look worse, and their patient care is almost non-existent.

The excuse I hear from other providers is that their company isn’t very good. Their lack of satisfaction with the company is reflected in the work they do and how they represent the company. The result is that the company starts to increase their oversight and rules on their crews and the crews respond by increasing their complacency. It’s a viscous cycle that only drags everyone down further.

Can I make a suggestion? You’ve heard the expression that you can’t pick your relatives, right? Well the same can go for your employer. Jobs aren’t always easy to come by, take it from a guy whose been around EMS a while… Now you can quit your job, but unless the lot of you are going out en-mass you’re solitary act of protest doesn’t mean much to your employer. We are all replaceable and that is a hard fact for some of the younger EMS folks to swallow. Nobody is immune to this.

Fortunately you don’t necessarily have to like your employer, just like you don’t have to like your family. You might not like representing them, but you do have to represent yourself. You should have respect for yourself enough to assure that your uniform is in good order and that your truck is properly maintained as far as your ability warrants. This makes you look good and competent. Carrying a chip on your shoulder because working private EMS is boring or lacking in glory doesn’t help the overall cause. When you take your aggravation with your lot in life out on yourself and your employer you’re not only making you and your boss look bad, but the rest of us in EMS as well.

Nurses used to be considered tantamount to a maid service, but look where professionalism and education got them. They proved themselves to be worthy of more and they received it. When you provide lousy patient care, complain about your circumstances, and fight with one another in the ranks you are preventing us from growing bigger and more powerful. One of the biggest things you’re going to learn as an adult is that you are entitled to nothing. Not a damn thing, regardless of your race, sex, orientation, or profession. If you don’t present yourself as deserving more, push your medical directors for more instruction while showing them you’re capable of more then you are always going to be thought of as surly ambulance drivers.

Those of you who believe that it’s time we got more respect and responsibility in EMS: I couldn’t agree with you more. YOU need to be the ones who bring it about though. Don’t wait for someone else to do it for you because as it stands you are the only person who is responsible for you. Join those of us interested in making EMS what it is capable of being. Be accountable for yourselves and be willing to take those extra steps to see that concept become a reality.


James Windale is the author of Twenty-Five at the Lip, a novel about EMS. His second novel Tuesday’s Gone is scheduled for release in June of 2015.

Click here to get Twenty-Five at the Lip on Amazon in paperback or on Kindle.

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2 thoughts on “Respect in Private Service

  1. As a paramedic for 18 years, you do not leave a good impression of our industry by your words in this blog. I only hope that your books you are putting out put our industry in a better light. First off, I am an 18 year paramedic who has worked rural 911 and private EMS. I am now a dispatcher for the past five of these 18 years in this occupation. You do not have anything nice to say regarding private ambulance services, only negative. I happen to work for one of the largest private and 911 services in the United States, which happens to be an employee-owned company. We pride ourselves in the service we provide by keeping our equipment up-to-date, clean and in working order. Our company not only has 911 areas as well as private EMS areas, but we also go off-shore, fixed wing patient care transport, a medical alert service to home bound individuals and also our own university where we offer individuals an EMS education within and from without our company. If I were not in the industry, by reading this blog, I would have the impression that every private EMS company within is nothing but sorry, lazy slobs, and that is NOT the case. There are however many of your quotes that I do agree with. We should remain humble, take pride not only in our unit and our equipment, but also take pride in ourselves.

    Now to the topic of dispatch…..

    As a dispatcher, I do know what it is like on the streets working and to post on the side of the road in the middle of the night waiting for a unit to return back to their district so that I can go back to mine. I do know what it is like to run all shift with not that much to eat or grabbing something from the gas station. It sucks, but I have not forgotten what that is like. First and foremost, I am professional with each and every caller that calls for our service. I give them a reasonable ETA and if we are going to be late, we call and let them know. And most of all, I take care of my crews. I am there for them, to get them what is needed to make their job easy and flow in a professional manner. I have an excellent working relationship with them and we get the job done…TOGETHER. Our company offers CCT capabilities, mobile healthcare to hospice patients, ALS and BLS services. And this started with the dreams of three young men in the 1970s who decided to start their own company. If someone needs to be picked up out of their floor and they call us, we do it, and yes we are a private EMS and 911 provider. I’m sorry that you have had such bad experiences with private EMS as have I, but do not put all private EMS companies in that category.

    On a more positive note, I do respect your attitude on being a positive professional. We need more positive in our profession. I firmly believe that each of us in this profession should lead by example and always humble yourself in this profession. If you don’t, someone could get hurt or killed with a know-it-all attitude. I wish you nothing but success in your journey with your books and your EMS career. Do not take this reply as me being a hater, please just take it as my opinion. Be safe in all that you do.

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  2. I think part of the problem is that there are those out there in Commercial and even volunteer EMS who don’t want higher standards in education because ” It’s tough to find people already.” My company does not even require Nat. Reg. They would have to pay for the training per contract. Further Paramedic mills are cranking out people with little, if any experience. Like I said this is only part of the issue, but a factor nonetheless.

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